1871510586 NPI number — DR. TILAK WIMAL WIKRAMANAYAKE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871510586 NPI number — DR. TILAK WIMAL WIKRAMANAYAKE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WIKRAMANAYAKE

Provider First Name:

TILAK

Provider Middle Name:

WIMAL

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1871510586

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/31/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5271 HUNTING HILLS DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ROANOKE

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

24018-8722

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

917-693-9253

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5271 HUNTING HILLS DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROANOKE

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

24018-8722

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

917-693-9253

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  226651 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00226651 . This is a "METROPLUS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 0101424-01 . This is a "AMERICHOICE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 052AR1 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 31P1291 . This is a "NY PRESBYTERIAN COMM HEAL" identifier . This identifiers is of the category "OTHER".
• Identifier: SP15105 . This is a "CENTER CARE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 02200911 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 112424557WI03 . This is a "CAREPLUS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 164680101 . This is a "HEALTHCARE PLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 112424557 . This is a "MULTIPLAN, INC" identifier . This identifiers is of the category "OTHER".
• Identifier: 166517 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 040426030250 . This is a "FIDELIS CARE OF NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P2527450 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".